- Sunshine Enterprise USA LLC
- Orange, CA
- 03-09-2024
Job Description
We are looking for a dedicated and detail-oriented Medical Case Manager (LVN) specializing in Long Term Care to join our team at Sunshine Enterprise USA LLC. In this role, you will be responsible for evaluating and processing requests for medical services, maintaining communication with healthcare providers, and ensuring compliance with organizational protocols and policies.
Responsibilities
- Review and process authorization requests for medical services related to CalAIM and LTC.
- Utilize Plan Health and CalAIM criteria to approve referral requests from healthcare professionals.
- Work closely with health networks, providers, and clinical facilities to coordinate member care.
- Maintain accurate documentation and data entry for all interactions and authorizations.
- Identify areas for staff training and development in collaboration with the Long-Term Care manager.
Requirements
- High School diploma or equivalent required.
- Current LVN license in California with a minimum of 3 years of nursing experience.
- Experience in clinical nursing review and utilization management preferred.
- Strong knowledge of medical terminology, CPT-4, ICD-10, and HCPCS codes.
- Effective communication skills and ability to establish positive working relationships.
Preferred Qualifications
- Experience in managed care and concurrent review processes.
- Proficiency in English and one of the defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese) is a plus.
Benefits
- Competitive salary range: $33,000 - $54,930 per year.
- Health, dental, vision, and life insurance coverage.
- 401(k) savings plan and recognition programs.
Join Sunshine Enterprise USA LLC and be part of a team that values diversity, growth, and professional development. Apply now to start a rewarding career journey with us!